Principles of disaster management

Principles of disaster management

1. Principles of Disaster Management Kerry Gomes

2. Perspective Each day 20,000 Australians are treated at hospital Emergency Departments and 5000 are transported by ambulance. “ We have never had an event with 20,000 casualties in Australia, Except every day!” So what do we need to do that is different in disasters?

3. Outline Definitions. ‰ History and epidemiology ‰ Risk assessment and management ‰ Disaster Management Principles ‰ Response Management Framework ‰ Issues, Myths and Problems ‰ Questions

4. Disaster Definition

5. Disaster Definition “A serious disruption to community life which threatens or causes death or injury in that community, and damage to property which is beyond the day-to-day capacity of the prescribed statutory authorities and which requires special mobilisation and organisation of resources other than those normally available to those authorities .” EMA – Australian Emergency Manuals Series

6. Types of Disaster Natural Seismic Earthquake Volcanic eruption Tsunami Celestial collision Climatic High winds (Storm , Cyclones, Tornado) Precipitation (Rain, snow, Ice) Lightning (fire) Temperature extremes (Hot and cold) Erosion Drought Desertification Floods Avalanches Man-made Technological Release of substances (Chemicals, Biological , Nuclear) Transport Structural failure Explosions Fire Environmental interference Conflict Conventional war Armed conflict/Civil conflict Complex human emergency Terrorism Unarmed conflict (Sanctions, embargos)

7. Disaster Epidemiology In the past 50 years - more than 10,000 disasters reported. - more than 5 billion people affected. - more than 12 million persons killed. - economic costs > $ 4 trillion USD. (Note: By comparison Australia’s GDP in 2006 was US$ 0.75 trillion ) Centre for Research on the Epidemiology of Disasters - CRED

8. Are disasters Increasing? Improved reporting CNN as first responder Increased population and density 3m people now live in the vicinity of Vesuvius Cities in high risk areas 64 of the largest cities in world in seismic zones or flood plains. Global warming Increased storm activity Increased technologies Mass transport Chemical industrialisation Transport of dangerous goods Economic stress Urban slums in dangerous environments Armed conflict Terrorism

9. Cost of Disasters Medical Public Health Sanitation / H2O Shelter / Clothing Food Energy Supplies Search & Rescue Public Works & Engineering Environment Logistics / Transport Security Communication Economy Education Human Costs Deaths Injuries and illness Loss and grief Economic Costs Actual Costs Intangible Costs

10. Why are Disasters Different? Number and variety of casualties. Initial disorder. Initial lack of resources. Effects on health system / community. Loss of infrastructure Need for multidisciplinary teams. Multiplicity of tasks. It is not just an increase in medical effort that is needed but a different medical approach also.

11. A Paradigm Shift All for One vs One for All

12. Dual Wave Casualties arrive in a dual wave Early victims 30 minutes with less severe injuries Self extricate Bystanders More seriously injured in second wave (60 – 90 minutes) by which time beds are occupied Bystanders Emergency Services

13. Approach to Disasters Prevention / Mitigation Preparedness and planning Response Recovery

14. Prevention / Mitigation “ Regulatory and physical measures to ensure that emergencies are prevented, or their effects mitigated ” EMA – Australian Emergency Manuals Series. Activities which eliminate or reduce the likelihood or impact of a disaster. Includes long term activities which reduce the effects of unavoidable disasters . e.g. building standards Cost effective mitigation measures are the key to reducing disaster losses in the long term.

15. Prevention / Mitigation Zoning / land use management Building codes Building use regulations Relocation Safety improvements Legislation Public Information Community awareness and education Tax , insurance incentives or disincentives

16. Preparedness and planning “Arrangements to ensure that , should a disaster occur , all those resources and services which may be needed to cope with the effects can be rapidly mobilised and deployed” EMA – Australian Emergency Manuals Series. Activities to anticipate what problems are likely to emerge in future disaster situations and to devise ways to address these problems and enhance ability to respond when a disaster occurs . Key element is developing plans Must have plan to respond, trained personnel to respond and resources with which to respond.

17. Preparedness and planning Community awareness and education Disaster Plans Training and test exercises Disaster communications Mutual aid agreements Warning systems Resource inventories Provision of special resources Evacuation plans “Tsunami Wave”

18. Preparedness: Planning

19. Preparedness: Disaster Teams Teams must be self sufficient If not then may be a “second disaster” victim country forced to feed and shelter extra people from already limited resources limited usefulness if no supplies / power e.g . Bam earthquake no power for 2 days Should include base camp equipment, field hospital , medical supplies, water, food, sanitation , power.

20. Preparedness: Surveillance Mechanisms to identify disease trends Mechanisms to monitor risks including monitoring vector disease e.g. Avian Influenza in birds Diagnostic capability Laboratories Reporting of infectious diseases

21. Response “Actions taken in anticipation of, during and immediately after impact to ensure that its effects are minimised and that people are given immediate relief and support ” EMA – Australian Emergency Manuals Series. Implementing plans Implementing disaster legislation or declarations Issuing warnings Activating disaster operations centres Mobilizing resources Notifying public authorities Providing medical assistance Providing immediate relief Search and rescue

22. The Response Management Framework A set of principles which provide a framework for managing any event. Command Control Coordination Communication Clinical Management Containment Continuity Capability Clapham Junction Train Crash

23. Command, Control & Coordination COMMAND : The direction of members of an organisation in the performance of roles and tasks. Operate vertically within an organisation. CONTROL : Overall direction of emergency management activities in an emergency situation. Operates horizontally across organisations. COORDINATION : The bringing together of organisations and elements to ensure an effective response, mainly concerned with systematic acquisition and application of resources in accordance with threat or impact. Operates both vertically and horizontally as functions of authority to command and control.

24. Communication The message Clarity of message (pre-considered) The means Consider the vulnerability of normal channels (e.g . mobile phones) Remember “the runner ” Radio codes The manner Pathways of communication Most common problem in any disaster is a failure in communication 1995 Oklahoma City Bombing Hospital called in “code black” their disaster active code EMS understood this as code for overloaded and sent them no patients resulting in overload of nearby hospital

25. Clinical Management Triage: Continuous and at critical points Diagnosis E ssential care Individual care based on normal practice Minimal care to ensure safety Priority for life and limb protection Clinical standards Respiratory support Circulatory support Documentation Family and contacts Decontamination Isolation Tokyo subway 1995

26. Triage - Red, Yellow, Green vs ATS Sieve Sort

27. Containment Containing the disease and reducing its spread Vector control Isolation and Quarantine Vaccination and antiviral prophylaxis Border control Social isolation Equipment including PPE

28. Continuity Maintenance of essential services Workforce protection with enhanced infection control, PPE, isolation of patients and anti- viral’s Access to business Maintenance of the food supply Creating capacity Protecting essential services

29. Capability Increasing the capability of the system to manage by preparation Information and awareness of personnel through education Vaccination Preparation and possible stockpiling of equipment and consumables. Health Capability Level 1 concentrate expertise utilising existing infrastructure Level 2 Preserve infrastructure for the event by early discharge , limiting non-urgent activity Level 3 Expand health infrastructure through system wide management , growing capacity and importing capacity Level 4 Ration access to health infrastructure through triage of patients

30. Recovery “The coordinated process of supporting disaster affected communities in reconstructing their physical infrastructure and restoration of emotional, social , economic and physical well being ” EMA – Australian Emergency Manuals Series. Restore infrastructure and the social and economic life of a community to normal Restore vital life support systems to minimum operating standards . Long term recovery to restore economic activity and rebuilding infrastructure. It should include mitigation as a goal

31. Recovery Restore essential services Community rehabilitation Counselling Temporary housing Financial support or assistance Health and safety information Long-term medical care Physical restoration/re-construction Public information Conducting economic impact studies

32. Transport Principles Right patient, right place, right time, by right means Patient transport requires regulation and distribution: where & when Distribute patients widely to prevent single institutions from becoming overwhelmed whilst others underutilised (if able to) Transport patients by those services which normally do so Quality of patient care during transport is usually more important than mode of transport May require improvisation

33. After the Disaster Equipment Review Debriefing Review of Plans Documentation Education and Training Research Rehabilitation Restoration Function Safety Assessment Emotional Impact Recovery Process Research Opportunities We need to ensure that we learn from our experiences as well as ensuring the well being and recovery of our community .

34. Take home Major Incident Medical Management and Support Approach (MIMMS) C – Command and Control S – Safety C – Communications A – Assessment T – Triage T – Treatment T – Transport